I write and speak about subcultures, sexuality, and new media.

Hey, you know what word should never have “super” in front of it? “Gonorrhea.” But super-gonorrhea is here. It’s far scarier than our former adversary, and it’s a serious threat, emerging from Japan and beginning to cross the world. News first started breaking in the public health community about super-gonorrhea years ago, but it’s finally hitting the mainstream, as for example in this recent article at RH Reality Check by Martha Kempner: “No Clapping Matter: Antibiotic-Resistant Gonorrhea Is On Its Way, and We Are Not Prepared.”

As I think about super-gonorrhea, my mind inclines towards condoms and oral sex, and my experiences as a sex educator. As Kempner’s article notes, many gonorrhea tests wouldn’t detect an infection that came from oral sex. And plenty of people don’t realize that you should use condoms during oral sex to prevent disease transmission. The risks for most diseases usually aren’t as high as they are during vaginal sex, and certainly not as high as the risks during anal sex. But the risks are there.

I know this as well as anyone; I’ve worked as a sex educator both in the USA, and in HIV-rich populations of sub-Saharan Africa. Living in an area with an overall HIV rate of 25% taught me a lot about the statistics and issues surrounding safer sex, and also scared the hell out of me. But I’ve still taken occasional unwise risks when it comes to condoms and oral sex — or, when I was younger, other types of sex. And plenty of other health educators I know have taken unwise risks, too. The dirty little secret of sexual health promotion is that while health educators may be better at health stuff (?), we’re nowhere near perfect at the ideals we espouse. (Just watch for people standing, smoking like chimneys, outside the doors of public health conventions.)

Why do people risk their lives for a heated moment? One reason was articulated by Kerry Cohen at Role/Reboot, as she wrote movingly about her past experience:

Unless he reached for [a condom] — and he so rarely did — I was never going to put my physical health over the intoxication that came from owning him, from losing myself, from letting him lose himself in me. … as he moves toward me, I won’t think about my body as anything other than something that could hook him, reel him in, and make him mine. I won’t catch an STD that time, but I might the next time. And if I catch something, I will still strip down to my core, exposing everything to the other person, even the STD. The shame I have about that runs deep — for the desperation, for the selfishness, for the utter lack of care for anything other than my need.

The reasons people don’t use condoms (or dental dams) frequently start and end with physical pleasure. But there’s often an emotional component as well, with people associating lack of condoms with trust or intimacy — or hating to “break the moment.” There is also the self-conscious agony of disclosure, when one partner knows that they have a disease. This was recently shown in an interesting, anonymously-written piece at The Hairpin, “The Perks of Herpes.” The author talks about how uncomfortable it is to disclose her herpes infection to every partner, every time. She ends up concluding that herpes (which she contracted from oral sex, by the way) actually has an up side: it’s deepened her love life by forcing her to only date men who are committed to her despite the disease. But I will point out that she’s in the sought-after position of being an educated young lady. Her trade-offs might feel very different for other people.

Indeed, when people are poor or marginalized enough, the human motivations around these diseases can become hard for privileged people to understand. For example, there are cases of people deliberately contracting HIV. At one point, it was because France — in an attempt to contain the spread of HIV — extended citizenship to undocumented HIV-positive immigrants; some immigrants then commenced to deliberately seek HIV, reasoning that being undocumented was worse than HIV. Lest anyone think that this can’t happen in the USA, it’s been described in Detroit, albeit for different reasons.

When people talk about HIV in Africa, they often like to focus on the differences between various African cultures and USA culture. (They also like to talk as though Africa is one big country instead of an incredibly diverse continent, which I am trying to avoid in this piece; I apologize if I’ve failed.) Yet although culture matters — it matters a lot — humans are humans all over the world. The USA has better overall health than the hardest-hit areas of Africa simply because we have more resources, but as I’ve already shown you above, marginalized USA people can end up making health decisions that privileged ones find unthinkable. And even privileged USA people will screw up our condom usage, like in Kerry Cohen’s story (she notes in the piece that her mother is a doctor).

People want to believe that sexually transmitted infections can’t happen to them, saying that HIV or whatever only happens to “those other people.” But the truth is that although stigma, marginalization, and cultural differences make some groups much more vulnerable to disease, people also have sex with other people from all walks of life … and global networks are more interconnected than ever. The history of HIV shows millions of people dismissing it as “the gay disease,” or “that epidemic that’s storming across Africa,” etc. But plenty of folks have caught it who were straight, in the USA, or even believed they were in a monogamous relationship. Gonorrhea has always been easier to catch than HIV; with no treatment, super-gonorrhea will ravage us. I can only hope that some of us will keep in mind not just the physical risks at hand, but the emotional ones. I hope we will consider how to manage the risk-reward tradeoffs that everyone makes.

UPDATE, September 2012: A recent New Yorker article apparently stated that super-gonorrhea is actually bred in the throat, which means that oral sex may actually be riskier, STI-wise, than other forms of sex. Food for thought.

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The image at the beginning of this post shows a model wearing a dress made entirely of condoms; thanks to the gallery at the website for The Wisdom of Whores, Elizabeth Pisani’s incredible book about the HIV epidemic and the international response. Pisani’s book is one of my favorites, ever — there are some valid critiques to be made, but even with those in mind, I just love it.

And! There are pieces about my experiences in Africa in my collection, The S&M Feminist: Best Of Clarisse Thorn. You can buy The S&M Feminist for Amazon Kindle here or other ebook formats here or in paperback here.

9 responses to “Super-Gonorrhea Is Here”

this is so worrying although on the bright side reading anything like this gives me a good reminder to make sure boundaries about condom use are really rigid in my (open) relationship.
a little off topic but I am just wondering how your work as an STD educator interacts with feminism/sex-positivism? the most damaging kind of slut-shaming I have encountered has been the comments and assumptions about how I ‘must’ have every STD going as a woman who has had casual sex, to the point where now I am really uncomfortable even reading stuff like this and constantly fear that I will somehow turn out to carry something despite testing negative multiple times and having no new partners since. I sometimes imagine it would help if I hadn’t had moments of irresponsibility about condom use when I was younger but I also feel like the stigma is detached from reality and linked to an idea that casual sex ITSELF regardless of safety is somehow contagious and damaging (a lot of the shoddy reasoning I have heard seems to centre around it being dead cert that you will catch an STD through protected casual sex but impossible in a relationship even without having been tested). I tend to find that my sense of personal vulnerability on the issue is hard to process concurrently with a desire to educate and talk about safe sex…just wondering if any of this gels with yr experience working in the area?

My understanding is that the research actually shows that HIV is more often caught during long-term relationships, not during casual encounters (including ostensibly “monogamous” relationships). This may be less true of gonorrhea than HIV because HIV is particularly difficult to catch in a single sex act — that is, the chances of contracting HIV during a single sex act are very low. But I’m not sure, and even if it is less true of gonorrhea, I still suspect that gonorrhea is also very commonly contracted in long-term relationships.

So. That’s an important truth that people need to know. From there, the way STD prevention intersects with sex-positive feminism is by encouraging open communication for all partners (including those in long-term relationships), which is something a lot of sex-positive activists seek anyway as a way of clarifying consent and promoting pleasure. Also, trying to mitigate problematic relationship dynamics is huge. A lot of the time, people who have risky sex know that they’re having risky sex, but they do it because they’re desperate or scared for some reason (e.g., they’re in an abusive relationship with their spouse, or they’re a sex worker who is paid extra to have unprotected sex, or see Kerry Cohen and the other examples I offered in my post above). So mitigating those factors becomes a huge factor in working against STDs, and that’s quite compatible with sex-positive feminism too.

Working towards public health in general is really hard, though, and comes with a lot of knotty and difficult factors. I wrote about this a bit while I was in Africa; the best essays are in my book The S&M Feminist. The original versions of those essays (which are slightly less clear and well-edited) are here:

On a side note, its interesting that in my comment i felt the need to point out that my relationship isn’t monogamous to ‘justify’ me stressing about condoms, but a lot of the articles point out the risk that remains in exclusive relationships. I imagine its v complicated socially to insist in that situation – when i have done it i’ve always lied that its for birth control reasons…

I’ve just watched a documentary on the BBC’s “Horizon” programme about the general problem of “superbugs”, and talking about the various efforts to deal with them. Both the quest to find new antibiotics (a female professor going to the farthest and least-accessible corners of the Earth to find them, it seems like there would be a video game about her); the attempts to use bacteriophage viruses (which each tend to be specifically targeted to certain types of bacteria, so you need the right strain to combat the right bug); and the intriguing discovery that it might be possible to block the transmitter chemicals that communally trigger the harmful effects of bacteria.

All the same, the scale of the problem is terrifying, and you can imagine STIs like gonorrhea are not going to be a priority for the researchers on the bacteriophages, for example. And all the research seems to be many years off from practical treatments available at your local healthcare provider.

I HAD NO IDEA. This is scary. I had unprotected oral sex (giving and receiving) in 2011 and 2010. Both of my partners had been tested for STD’s and the doctor found nothing. I also got tested and haven’t found anything. I am not sexually active right now. Do you think I need to take another std test because I might have gotten gonorrhea from oral sex and they didn’t detect in the std tests?

If your partners didn’t have it then your risk is pretty low. You could try asking your doctor to do a test on your throat instead of just your genitals …. I’d actually be interested to know how that would work out. From Kempner’s article, it sounds like a lot of doctors wouldn’t quite know how to do that, and would be very surprised by the request. If you’re really scared it might be worth trying. But again, it sounds like your risk is low.

About Clarisse

On the other hand, I also wrote a different book about the subculture of men who trade tips on how to seduce and manipulate women:

I give great lectures on my favorite topics. I've spoken at a huge variety of places — academic institutions like the University of Chicago; new media conventions like South By Southwest; museums like the Museum of Sex; and lots of others.

I established myself by creating this blog. I don't update the blog much anymore, but you can still read my archives. My best writing is available in my books, anyway.

I've lived in Swaziland, Greece, Chicago, and a lot of other places. I've worked in game design, public health, and bookstores. Now I live in San Francisco, and I make my living with content strategy and user research.